- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous
physical therapists on the internet.
- In our opinion of course, Bob.
- Is your calf pain a blood clot?
- My cat? - Calf.
- Oh, calf. - Calf. Yeah.
- Okay. No, I mean, I don't know.
- This is actually a very serious subject, Brad.
- Right.
- I mean, if you get a blood clot in your calf
and I'm gonna talk about this right away.
- Sure.
- If that clot can break off
or a piece of it can break up,
travel up into your lungs - Hm mm.
- and actually block off a part,
an artery in the lung
to the point where it kills off that part of the lung
and you're gonna become short of breath
and you can kill you. - Sure.
- There's 600,000 cases a year
and of those 60,000 people die.
So-
- And the tech,
the technical term is deep vein thrombosis, right?
- Right.
Because it's a deep vein
and thrombosis means clot.
To give you an example, Brad,
I don't, if you remember David Bloom.
He was a reporter for NBC during the Iraq war.
- Hm mm.
- And he got it from,
he was 39 years old, healthy,
but he was traveling around in tanks
with the troops. - Right.
- And he was immobile for a long period of time.
And that's probably one of the number one causes of it.
Is immobility. - Right.
- And he actually developed a clot,
went up to his lung, killed him.
- Right.
- So, I mean, this is a serious subject, so-
- And so, we're gonna go through a test
that physical therapists use on a regular basis.
- Very simple test and kind of some
of the things we look for and- - Sure.
- it's called the Homan's test or Homan's sign.
- Hm mm. - Right.
And I've probably
assessed at least a half dozen Brad.
- Hm mm.
- And that I was right on
and I've been wrong too
and I know you've been wrong. - Right.
- It's better to be wrong and send somebody in
- Right.
- than to, you know, not send them in and-
- Right, so in other words, you perform the test,
which takes about a half a minute.
- Right.
- If the tests are positive, you send them in
and then they get the test through an ultrasound.
- Right, like a Doppler ultrasound.
- Right, and that confirms it.
- I think they could do an MRI too,
but ultrasound is so much cheaper
and they always do an ultrasound.
- Right. - So.
- And if it's positive, they take,
you know, they'll take care of that.
We're good at that.
If it's negative-
- Ah, coumadin and warfarin,
they'll put you on something like that.
- Right. - Exactly.
- If it's negative, they come back and yeah,
that's good news.
- So, alright.
Homan's test. Very simple.
First thing what I do, you know,
it generally happens in the calf.
- Hm mm.
- I know a thrombosis can happen up in the thigh too.
- Right.
- I've never seen one.
I know it happens. - Right.
- I just never have seen one, so.
It always seems to happen in the calf for me.
You're gonna notice first off that it is swollen,
especially on one side compared to the other.
- Right. - You know.
And you're gonna have swelling after surgery quite often.
So that alone is not a sign. - Right.
- So, I also notice usually there's some redness,
they, the person themselves may feel some burning pain.
- Hm mm.
- You know, there's gonna be sometimes pain,
discomfort there,
but this is burning pain quite often.
- Right.
- So swelling, redness, some pain
and, you know, probably roll down the larrup, so.
Alright, you're gonna have the leg straight.
Now they can do this in bed too very easily.
- Sure.
- And basically what we call is Dorsiflex the ankle.
We bring the toes up towards you,
up towards the head.
- Toes, towards the nose
- Towards the nose. There we go.
And sometimes that alone will bring on the pain.
- Right. Hm mm.
- And if not you squeeze here - Hm mm.
- and it's not usually very subtle.
Right, Brad?
- Right, go ahead and do that.
- Yeah, I go like that- - OW!
And then, you know, - Yeah.
Person'll issue, eyes will open, they'll jump up.
- That's what really alerts me to it.
If they go.
And the other thing I'll often do
is I'll squeeze on the other side too, Brad.
- Sure.
- And then they go, "OW," just as bad.
- Yeah.
Then I'm like, "They're just a very sensitive person
or their calf is really sensitive."
- Right.
- But that's a simple test, the Homan's test.
And you know, if there's some reason why
you could have a clot, you know,
then you're more likely to go have this checked out.
- Sure.
- So should we talk about some of the risk factors?
- Well, I guess in my experience, I'll do the same test.
I'll look for the swelling, but there's swelling
for other reasons. - Right.
- I'll squeeze here.
It might be painful.
I'll dorsiflex if that's painful.
But I found that, you know, it's a judgment call.
- It is a judgment call.
- Is it just a, "ouch?"
Or if it's a, "OW!"
- Every time I've seen one, Brad,
what I do is I bring a nurse in then too.
- Right.
- Every time I go, "This is what I'm seeing.
What do you think?"
And quite often they'll, you know, "I concur."
- Right. - So.
- And if it's in a gray area, I'll send them in.
- Yep. You send them in.
Especially, you know, a lot of the people we're seeing
are after surgery,
which is of course one of the risk factors.
- Sure.
- Let's kinda go down the list, Brad.
Again, prolonged bedrest.
But the other one is that a lot of people do
is sitting in a car or sitting in a plane
for a long period of time. - Right.
- So what should they be doing
just to prevent this?
- They could be doing some ankle pumps.
- Yeah.
Can you see this at all?
- [Camera Person] Hm mm.
- Yep. Working those ankles - Yeah.
- all the way up and down.
Not just little wiggly's, - Yeah.
- but good, meaningful ankle pumps.
- I do these on the airplane all the time, Brad.
- Sure.
- I'm tappin' away or pumpin' away.
The other thing, which actually I didn't know,
is dehydration makes you more at risk.
- Sure. Hm mm.
- You wanna make sure you keep your fluids up
while you're on the plane.
If you have inherited,
you might have inherited a blood clotting disorder.
You know, if your parents have had it.
- Sure.
- If you or any of your parents had a DVT,
a deep vein thrombosis,
you're more likely to have one too.
- Yeah. - So.
- There's nothing you can do about that.
- Yeah, there's nothing can do about that,
but what you do want to do is be self-aware
that you may be more likely to get one.
- Right.
- Another one, Brad? - Smoking.
- Smoking.
Yep, that's always one. - Right.
- Obesity.
Heart failure.
Keep going.
- I can't read your writing.
(both laughing)
- Brad can't read my writing.
- Well there's a whole list there.
- Inflammatory bowel disease.
Age, if you're over 60.
we already said the fly me family history.
Pregnancy. Did we say pregnancy?
- .No
- Same thing happens with pregnancy, doesn't it?
- Right.
- If you're on birth control pill
or hormone replacement therapy.
I think that's the vast majority of it, Brad.
- And treatment, like we said,
usually it's not the therapist's job
to treat. - Right.
Oftentimes if they have one we're not gonna walk 'em.
- Right.
- You know, they're gonna stay off of it,
cuz we don't want to irritate it.
- Right.
- They gonna put 'em on warfarin some kind
of oral medication. - Or coumadin.
Yeah, yeah. Something like that.
That's of course in your family doctor's
or your doctor's-
- Right. Any idea what that is,
it's gonna dissolve the clot
and it's gonna break it up. - Right. Exactly.
- That usually takes a period of time.
- Yep, it does. - Hm mm.
- So, that's it.
There's not much more to it Brad.
Do the Homan's test and again
don't be playing with your life here.
If it looks like it's bad,
go in and have it checked out.
- Right.
And on the lighter side,
we can fix just about anything outside your leg
except for?
- Oh, a broken heart.
- Broken heart, yeah.
- Aah, you see-
- But we're working on that.
Continue to do home, home study work on that.
We talk to our spouses about it.
We're gonna get good PhDs on it.
- No, we won't. No, we won't.
- We won't?
- Night. - Well, we may.